go back

Nebraska rates for HCPCS L7402

Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, ultra-light material (titanium, carbon fiber or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $281.84 / $281.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $281.84 / $1,905.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $426.58 / $436.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $316.23 / $501.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $512.86 / $758.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $489.78 / $2,089.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $263.03 / $436.52
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $616.60 / $1,122.02
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $501.19 / $501.19
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $758.58 / $1,122.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $302.00 / $457.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $223.87 / $338.84